CT mandates 2026 insurance coverage for biomarker tests

As tests and screenings for chronic conditions improve, Connecticut residents will have better access after lawmakers passed legislation mandating health insurance plans cover biomarker tests starting next year.

Connecticut joins more than 20 states mandating insurance coverage cover biomarker tests, said Christy Kovel, director of public policy at the Alzheimer's Association Connecticut chapter.

"People should feel hopeful that we have secured a major policy advancement, that it's going to help families who are going through the diagnosis process, not just for Alzheimer's, but for other diseases like cancer," Kovel said.

Biomarkers, short for biological markers, are measurable changes in a person that show if a disease is present or if they are at risk of developing it. Kovel said that the types of biomarker tests available can vary, but they often include either imaging scans or collecting samples of body fluids or tissue.

Historically, biomarker testing has been used primarily in the diagnosis of cancer and autoimmune diseases; however, as technology has improved, it's also being applied in early detection efforts for neurological conditions, such as Alzheimer's and Parkinson's disease. Medical providers also use biomarker testing to help determine the best treatment plans, but access to these tests isn't always equitable.

Patients who are older, Black, uninsured or Medicaid-insured are less likely to be tested for specific biomarkers, according to the Alzheimer's Association. There are also lower rates of testing in community settings versus in academic medical practices.

State Sen. Jan Hochadel, D-Meriden, said it quickly became evident that biomarker coverage was needed across the board during the public testimony portion of the legislative process.

"We had people with lung cancer, colon cancer, prostate cancer, all of them, and a lot of them said they weren't offered this or the insurance company would not pay for the biomarker testing, and unless they wanted to spend, like, hundreds of thousands of dollars," Hochadel said.

Roughly 57 partner organizations, including the Alzheimer's Association and the American Cancer Society Cancer Action Network, came together to create and push for insurance coverage for biomarkers, Kovel said. The first success was last year when Connecticut passed biomarker coverage for Medicaid enrollees; however, it didn't include private health insurance companies.

Thanks to the new law, which takes effect Jan. 1, 2026, health insurance policy providers offering coverage in Connecticut would be required to cover biomarker testing through an in-network laboratory to diagnose treat, or help manage and monitor the progression of diseases if there's medical and scientific evidence that it'll improve their health outcomes.

The mandate applies to both individual and group health insurance policies. It'll also require health carriers to establish a process for requesting an exception to coverage and disputing a coverage decision while also setting specific prior authorization requirements.

In addition to the biomarkers, the law establishes a 15-member Alzheimer's Disease and Dementia Task Force to continue developing and updating the state's Alzheimer's Plan starting in October.

Kovel said the new task force would build off the grant-sponsored work through the state Department of Public Health. The goal is to study the current medical and support services available to Alzheimer's patients and their caregivers, as well as their barriers to care. The convened group would help develop state policy recommendations for systemic changes to improve long-term care facilities management, data collection, education and more.

Improving quality of life

The biomarker coverage was passed through the state legislature as part of the larger omnibus bill proposed by the state's Aging Committee, which had support from more than 90 legislative co-sponsors and bipartisan support in both the House and Senate.

The legislation, signed by Gov. Ned Lamont earlier this summer, aims to improve access and quality of life through a handful of initiatives.

"What this whole bill was about is if we can catch things quicker, get treatment quicker, [it] lets people live with more dignity for longer times," Hochadel said.

The bill includes provisions, for example, that waive tuition at online regional community colleges for nursing home residents regardless of age. The idea behind it, Hochadel said, was born out of the fact that some nursing home residents are younger than people realize, but they don't have the familial support to live on their own.

The bill also introduces additional regulations and rules regarding the transfer or discharge of patients from long-term care facilities. Staff would need to consider how close a patient is to their family and known support networks when relocating them. Hochadel said this provision was born after hearing about the "devastating effects" of a sudden closure of a long-term care facility in Waterbury.

"Some of these people were transported to other places far away in Connecticut, and their families didn't have any transportation," she said, adding that many of them relied on public transit and couldn't visit their loved ones who'd been moved. "It was really heartbreaking. That's why we want to make sure that when these closures happen, that we can try and keep the family in mind as well."